Healthcare Provider Details

I. General information

NPI: 1063464097
Provider Name (Legal Business Name): CENTER FOR INDIVIDUAL & FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21751 ECORSE RD
TAYLOR MI
48180-1846
US

IV. Provider business mailing address

21751 ECORSE RD
TAYLOR MI
48180-1846
US

V. Phone/Fax

Practice location:
  • Phone: 313-291-7000
  • Fax: 313-291-0942
Mailing address:
  • Phone: 313-291-7000
  • Fax: 313-291-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHINE SHEEHY
Title or Position: PRESIDENT
Credential: ACSW
Phone: 313-291-7000